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General NPI Number Information
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NPI Number | 1780831016
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Entity Type | Individual
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Provider Name | CARLOS ANDRES CASTRO-PERDOMO DDS
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Gender | Male
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 1942 ATKINSON RD SUITE 500
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5003
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Country | US
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Telephone | 917-907-2185
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Fax |
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Provider Business Mailing Address
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Address Line | 1942 ATKINSON RD SUITE 500
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5003
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Country | US
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Telephone | 917-907-2185
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN013764
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN013764
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 056055
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License Number State | NY
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